Brain ischemia is one of the principal causes of death and disability worldwide in which prevention or an effective treatment does not exist. In order to develop successful treatments, an adequate and useful ischemia model is essential. Transient global cerebral ischemia is one of the most interesting pathological conditions in stroke studies because of the observed degeneration of forebrain and delayed neuronal cell death in selective vulnerable regions such as hippocampus. Transient occlusion of both common carotid arteries is the most convenient model to induce tGCI. Although there are effective rat and gerbil models using this method, the induction of a reproducible and reliable injury after global ischemia in mouse has presented higher variations, mainly because of its size and the necessary monitoring skills in order to accomplish homogeneous and reproducible results. Further, great variability among cerebral vasculature and susceptibility of the different strains and sub-strains is observed. In recent years, some modifications have been made to the model in order to normalize the heterogenic effects. Analysis of posterior communicating artery patency has been proposed as an exclusion parameter due to the direct relationship reported with the reduction of cerebral blood flow. Another method used to significantly reduce blood flow is the induction of hypotension with isoflurane. Each protocol produces distinct injury outcomes. Further improvements are needed to attain a general, simpler, reproducible and globally accepted model that allows comparisons between research groups, progress in understanding ischemia and the consequent development of therapeutic alternatives for ischemic injury. BACKGROUND The burden of stroke is high in Africa, but few data are available on the long-term outcome of strokes in this area. AIM We aimed to study the long-term outcome of stroke survivors in Parakou from 2012 to 2018. METHODS OF STUDY It was a cohort study and included 247 stroke patients admitted to the University Hospital of Parakou from January 1, 2012 to April 30, 2018. Each patient was followed up for at least 1 year. The modified RANKIN scale was used to evaluate patients. Verbal autopsy was used to ascertain the cause of death. The survival probability was estimated using the Kaplan-Meier method. Predictors of mortality were estimated using the Cox proportional model and the hazard ratio (HR) and their 95% confidence intervals were determined. The data were analyzed using Stata Software. RESULTS The mean age was 58.1 ± 13.4 years with a sex ratio of 1.12. Among stroke survivors, the mortality was 10.1% at 3 months, 11.7% at 6 months, 15.4% at 1 year, 21.5% at 3 years, and 23.5% at 5 years. The probability of survival after a stroke was 66.5% at 5 years. Factors associated with mortality were age with adjusted HR 1.4 (1.2-1.7) for each 10 years, male sex with aHR 2.3 (1.2-4.6), history of hypertension with aHR 2.0 (1.0-4.1) and the severity of the initial neurological impairment National Institute of Health Stroke Scale with aHR 1.1 (1.0-1.2) for each 1 point. The main causes of death were recurrent stroke, infectious diseases, and cardiac disease. The proportion of patients with functional disability was 53.8% at 1 year. The quality of life was generally impaired in terms of physical health, personal environment, and finances. CONCLUSIONS The long-term prognosis of stroke patients in Parakou is poor. It requires urgent action to reduce this burden. INTRODUCTION Faecal Immunohistochemistry Testing (FIT) is recommended as an adjunct to guide referrals from Primary Care for individuals without rectal bleeding, who do not meet the suspected cancer pathway referral guidelines. It has largely replaced Faecal Occult Blood Testing. AIMS To assess the specificity of FIT. To understand the characteristics of FIT negative cancer patients and whether they have predominantly right sided cancers. Evaluating the efficacy of FIT and Iron deficiency anaemia in combination to capture patients with colorectal cancers. METHODS A study of 1000 symptomatic patients, undergoing FIT by Clinicians during the 'Digital rectal examination’. Inclusion criteria; all patients referred via our cancer referral pathway. FIT positivity was set at 10 μg g of faeces. RESULTS There were 7 FIT negative cancers in this cohort; 1 was a lymphoma and the other 6 were caecal adenocarcinomas. 5 were anaemic. The positive predictive value of IDA was 34% compared with 'other symptoms’; 18%. The negative predictive value of FIT was 99.05% in this cohort. Specificity for FIT was 86.9% (CI 96%). CONCLUSION Two separate referral pathways for IDA and FIT positive tests, would have captured all patients except 2; the lymphoma and 1 advanced caecal adenocarcinoma. FIT is an excellent triage tool prior to colonoscopy however capturing right sided disease remains a weak point. Multivariate analysis of patients in addition to IDA and FIT should improve capture of this subgroup. Ketogenic diets (KDs) are becoming increasingly popular for the treatment of diabetes, yet they are associated with increased frequency of hypoglycemia. Here we report that mice fed a KD display blunted glucagon release to hypoglycemia and neuroglucopenia, suggesting that consuming a KD may increase the risk for iatrogenic hypoglycemia. Pseudomyxoma Peritonei (PMP) is a rare peritoneal malignancy, most commonly originating from a perforated epithelial tumour of the appendix. Given its rarity, randomized controlled trials on treatment strategies are lacking, nor likely to be performed in the foreseeable future. However, many questions regarding the management of appendiceal tumours, especially when accompanied by PMP, remain unanswered. This consensus statement was initiated by members of the Peritoneal Surface Oncology Group International (PSOGI) Executive Committee as part of a global advisory role in the management of uncommon peritoneal malignancies. The manuscript concerns an overview and analysis of the literature on mucinous appendiceal tumours with, or without, PMP. Recommendations are provided based on three Delphi voting rounds with GRADE-based questions amongst a panel of 80 worldwide PMP experts. INTRODUCTION Chemoradiation therapy (CRT) is the standard treatment for anal squamous cell carcinoma (ASCC) but can have significant treatment related toxicities. Recent studies have demonstrated the effectiveness of local excision (LE) for stage I ASCC with comparable oncologic outcomes to CRT. We aimed to evaluate this finding in a large population-based database. METHODS Patients diagnosed with stage I (T1N0M0) ASCC were identified from the Surveillance, Epidemiology, and End Results database, 2004-2015. Treatment approach was categorized as CRT or LE. Factors associated with treatment approach and cause-specific survival (CSS) were analyzed for the entire cohort and after stratification by tumor size (≤1 cm and 1-2 cm). RESULTS Among 883 patients, 56% had ASCCs 1-2 cm in size and 77% received CRT. Mean age was 60 years, 65% were female, and 90% were White. Factors independently associated with receiving CRT were, being female, higher tumor grade, and tumor size 1-2 cm. Unadjusted 5-year CSS for CRT was 96% while for LE it was 98% (p = 0.048). After adjusting for available confounders, treatment approach was not associated with worse CSS, however being Black (HR = 8.7) and uninsured (HR = 13.7) were independently associated with worse prognosis. After stratification by tumor size, there was still no significant difference in 5-year CSS by treatment approach. CONCLUSIONS LE was performed in a significant proportion of patients but was not independently associated with worse CSS compared to CRT. In appropriately selected patients with well differentiated ASCCs ≤1 cm, LE could be an acceptable management option but studies measuring outcomes such as local recurrence are needed. BACKGROUND AND OBJECTIVE Corticosteroid injection is an effective treatment for trigger digits but the pain during the injection is an ever-present side effect. Since the palmar skin has a high density of sensitive receptors, injecting through dorsal skin could be less painful. Our aim was to assess whether a dorsal technique through the dorsal web is safe for extra-sheath injection of trigger fingers and thumb. MATERIAL AND METHOD This is an anatomical study in sixteen cadaveric hands. An injection through the dorsal web was performed on each digit. After careful resection of the palmar skin, the distance between the needle and the main anatomical structures was measured. The risk of major injury was considered high when the mean distance from the needle to the neurovascular bundle was below 1mm. RESULTS The mean distance from the needle to the neurovascular bundle was 1.77mm. Two neurovascular injuries in 112 injections were observed, one nerve and one artery. The safest digit was the thumb while the most dangerous was the index finger. At the ring finger, the technique was safer when it was carried out from the dorso-radial. CONCLUSIONS A subcutaneous injection near the flexor tendon sheath can be carried out through the dorsal web with a low, but present, risk of neurovascular injury. It could be useful for injection in the treatment of trigger finger and trigger thumb but it should be assessed in a clinical study. BACKGROUND Obesity is a growing health problem that has become a global epidemic. Serial population studies have shown the same in Malaysia, where the prevalence of obesity increased rapidly in the last decade. Currently, bariatric surgery is the most effective treatment in patients with morbid obesity. Obstructive sleep apnea (OSA) is the most common type of sleep-related breathing disorder seen in obesity. OBJECTIVES We aim to ascertain the prevalence and severity of OSA in Asian patients who underwent bariatric surgery and were seen in our center. SETTING The study was conducted in our university hospital. METHODS Study approval was obtained from our institutional review board for a retrospective chart review. A total of 226 patients were included in this review. OSA was noted as absent or present and graded from mild to severe. The patient population was stratified by body mass index according to the World Health Organization guidelines for Asian population. RESULTS The overall sample prevalence of OSA was 80.5%. Of these, 24.3% had mild OSA, 23.9% had moderate OSA, and 32.3% had severe OSA. Only 17.3% have been diagnosed with OSA before bariatric workup. Among men, the prevalence of OSA was 93.7% and 75.5% among women. CONCLUSION Based on these findings, Asian patients undergoing bariatric workup should be considered for routine polysomnography to enable treatment of OSA. BACKGROUND Studies on receipt of statins and risk of multiple myeloma (MM) yielded conflicting results. This systematic review and meta-analysis was conducted in order to comprehensively investigate the relationship between receipt of statins and risk of MM. PATIENTS AND METHODS Potentially eligible studies that compared the risk of MM between statin recipients and those who did not receive statins were identified from Medline and Embase databases from inception to August 2019 using a search strategy that comprised terms for „statin” and „multiple myeloma.” To be eligible, cohort studies must have recruited 2 groups of participants, statin recipients and nonrecipients, and followed their participants for incident MM. Eligible case-control studies must have recruited cases of MM and controls without MM, and must have explored the history of receipt of statins. Relative risk, hazard risk ratio, standardized incidence ratio, or odds ratio (OR) of this association must be reported. Relative risk and standard error from each study were extracted and combined using random-effect generic inverse variance.